OP-ED

The Other Scarlet Letter

Do you hate abortion? Me too. Every form of the procedure sickens me, and has since the first one I ever heard about, when I was 10 years old.

My mother had come home early, distraught and bathed in tears, from her job as a teacher in a special high school for pregnant teenagers. Her school had let out early, following the news that a 15-year-old student had just died in the hospital from sepsis, a few hours after delivering a second-trimester, stillborn fetus she had impaled the night before with a knitting needle. It was 1972, a year before Roe vs. Wade.

No, it was not appropriate to explain abortion to a 10-year-old. And perhaps it was my overexposure as a child to the nasty realities of the world that continues to inspire my utter impatience with the nonsense running out of some peoples’ mouths, in particular moralizing politicians who are probably cheating on their wives, but that’s another story. The starkness and radicalization of my upbringing gave me a hair-trigger for spotting and calling out hypocrisy and collective self-delusion – especially when both are so obvious, no one else in the room seems to see them.

To wit: those who claim to be “pro-life,” whatever the hell that means, should get real about how the real world works. The “pro-lifers” in Congress leading the charge to dismantle Planned Parenthood should try listening to their own rhetoric about the inexorable power of market forces. Demand will always seek and find supply; and as demand for abortions will never go away on its own, neither will those who “supply” them, be they overseas physicians for the wealthy, discreet, chart-buffing physicians for the middle class, back-alley butchers for the poor, or desperate, do-it-yourself teenagers. Anyone who thinks I am kidding – and who has not had the benefit of an OB/GYN rotation in a public hospital and/or a politically furious mother with poor boundaries – should read or watch the blistering Revolutionary Road through to its bloody end.

The ugliness of abortion is one of the ugly facts of life, and it always has been. We just happen to talk about it now, the same way we talk about other previously taboo medical subjects like cancer, depression and erectile dysfunction. Perhaps I was hit on the head with too many economics textbooks, or maybe it is my inability to join in the decades-old group-pretend about the colossal waste of lives and money that is “the war on drugs,” but the rock-bottom fact of this ugly problem is simple: making abortion illegal and/or unfinanceable for poor girls and women will not make it go away; it will make it go underground, later-stage, bloodier, and far more horrifically violent to the very fetuses the “pro-life” people claim they want to protect.

So let’s start with a little bit of common sense, drowned out completely in the latest screaming match over abortion: the best way, paradoxically, to increase the already appalling number of elective abortions in America is to financially disable Planned Parenthood, as many in Congress have been hellbent on doing this week. Planned Parenthood is not “Planned Abortionhood,” as the demagogues would have us believe. It is a safety net provider of health screening, sex education, and birth control for three million American women every year, most of whom live in economic gray zones between Medicaid and good insurance and thus have nowhere else to go for pap smears and free condoms.

If the crusaders for the “unborn” actually wanted to eliminate abortions, they would be doing everything in their power to expand Planned Parenthood’s funding and full range of services. They would seek to fund this and every other avenue for the provision of basic health services for vulnerable girls and women. They would, of course, also hold their noses and support the health care reform bill – any health care reform bill – that increases access to basic health care services for poor women. They would work to create massive new systems to enable the adoption of unwanted babies of girls and women who choose not to abort. And they would be doing everything in their fiscal power to increase sex education in our schools.

Give girls and women access to all of that, and then you can run your mouth about what they should do with their bodies.  By contrast, if you are against providing girls and women with access to services that will reduce the number of unwanted pregnancies in this country, then you are either naïve, or stupid, or a shameless hypocrite who obviously cares more about punishing girls and women for their sexuality than you do about preventing abortion, and you should shut up for a minute and take a hard and honest look at your own attitudes about sex.

Now That I Have Your Attention

Among the tactics of the “pro-life” zealots who masquerade as “pregnancy counselors” and entrap terrified girls and women struggling with unwanted pregnancies is this brutal condemnation: “if you abort your baby, you will regret it for the rest of the life.” While this is tantamount to emotional terrorism, it also happens to be – for some unknown number of women who do terminate a pregnancy – sadly and painfully true. And while it would be a coup de grace if these same zealots and their clinic-bombing militia wing diverted their considerable free time and energy from the harassment of girls and women to the adoption of their unwanted children, the burden of course would be too great for them alone.

Luckily, there is a more scalable solution to the nation’s abortion conundrum, lurking not that far from the picket line in front of the women’s health clinic. In many cities, it is actually housed in a different wing in the very same clinic, the one where otherwise infertile women spend tens of thousands of dollars a year flooding their bodies with hormones and technology, in the hope that they might establish and carry to term a pregnancy their body obviously does not really want. In wildly disproportionate numbers, of course, these pregnancies do not go to term; many fetuses conceived through in vitro fertilization and intrauterine insemination come in twos, threes and fours, are born prematurely, and end up in the NICU, costing all of us hundreds of thousands of dollars more.

Welcome to the wild, wacky US health care system! OB/GYN residents get a special case of whiplash as they cross over, usually on one magical summer day, from residency into private practice, and they confront a near inversion of the world where they trained to the world they were training for: many of the poor, uninsured women they see in residency women’s health clinic struggle to deal with unplanned pregnancies; many of the well-off, well-insured women they see in private practice struggle to get pregnant.

And so – just sayin’ here – how difficult would it be to solve one problem in part by solving the other?  Large numbers of girls and women do not want children but also do not want to abort, while just around the medical complex’s corner, large numbers of parents will spend small fortunes and endure miserable, protracted interventions trying to have children. I understand that a major part of parenting involves the primacy of one’s own progeny; but everyone I know who has run the fertility technology gauntlet to no end, only to relent and adopt children, has all said – to a couple – “Why did we go through all that? Why didn’t we just do this in the first place?” And indeed, they appear to love their children every bit as much as parents with their own progeny.  How hard would it be to connect one set of desperate people with another?

Apparently, harder than it sounds. Around the country, there are a small number of poorly funded and barely promoted programs that match unwanted pregnancies with eager adoptive parents. But these programs, usually the only recourse for male couples and the last resort for other couples who have failed with fertility technology and want native kids, are highly marginalized. Might this have something to do with – surprise! – markets and money?  With the fact that overseas adoption is a huge cash business?  With the fact that the “fertility business,” and the high-risk pregnancies and complicated deliveries they tend to yield, generate billions per year in cash income for fertility specialists and third-party payer revenue for hospitals?

If the fulminators in Congress who claim to hate abortion wanted to do something useful about the problem, this would be the place to start. Social workers and normal deliveries are far cheaper than fertility specialists and NICU time; everybody wins, right?  Well, everybody except the doctors and hospitals, of course, which have been known, on occasion, to lobby Congress. But really: is this rocket science? Or is it simply another thing that is so obvious, no one has thought of it?

Or Maybe You Just Hate Hester Prynne More than You Hate Abortion

Meanwhile, back at our regularly scheduled screaming match.

As mentioned at the outset, since the age of 10 I have experienced and understood the visceral hatred of abortion shared by many Americans. And I commiserate fully with all who oppose everything about abortion (if not who oppose abortion rights) because of a spontaneous, heartfelt love of babies that is our humanity at its most tender. I too have held the miracle of a newborn in my weathered old hands, imagining with every nerve in my fingertips that I could feel its soft, warm, pink head growing right there, the cells dividing riotously, a precious new life emerging. And yes, this most blessed of all sensations makes the idea of anyone venturing into a pregnant women with their own hands and aborting a fetus at any stage absolutely repugnant to me.

But it is this very repugnance that should inspire us to do the exact opposite of what those who claim to be “pro-life” are trying to do right now. We should be doing everything in our power to stop unwanted pregnancies from ever occurring in the first place – and blocking girls’ and womens’ access to health care services at places like Planned Parenthood is exactly not how to accomplish this goal.

So let’s put a fine point on it: anyone who claims to hate abortion but does not support expanded funding of sex education, birth control, and women’s access to basic health care is a hypocrite. They are lying to themselves, imposing their own neuroses about sex on the rest of us, and actually helping to make the problem worse. They are miserable Puritan scolds who, unconsciously, obviously care more about punishing girls and women for their sexuality than “protecting the unborn.” They are stuck in the 17th century, with the cruel and mindless mob in The Scarlet Letter, one of the quintessentially American novels for woefully good reason. Worst of all, they are inadvertently helping stimulate demand for abortion.

It is safe to say that all reasonable Americans yearn for the elimination of elective abortion in America.  Some of us are grown up about the realities of the problem. We understand that girls and women have sex, many while under-age and out of wedlock, whether or not that happens to meet with our moral approval. We also understand that the best way to prevent abortion is by increasing rather than shutting down their access to birth control, education and health care benefits. Others by contrast would rather vilify, chastise and control women. They would rather force the government not just into their bedrooms, but all the way into their uteruses.  How odd that, on a different day in Congress, some of these very same people might actually mouth a homily or two about the virtues of market forces, individual liberty, and limited government.  They should be forced to wear a scarlet “H” – for hypocrisy – on all their clothing.

The rest of us who are willing and able to connect the dots between the heinousness of abortion, the realities of human behavior, and how markets actually do work recognize one overriding fact about abortions: they did not start with Roe vs. Wade, they will not stop with its overthrow by the mob, and they will not stop with the dismantling of Planned Parenthood. Abortion has been around for centuries, since the discovery of high-saline baths and “special teas” that induced uterine contractions.  Also around for centuries has been the realization that markets work, and that restricting supply in the face of fixed or increasing demand always results in black markets, the criminalization of desperate citizens, and often immense dislocations and suffering.

The best way to drastically reduce the number of abortions in America is simple: ruthless honesty about its causes and our own political compulsions; massive mobilization of systems to increase adoption; and doing everything in our power to increase girls’ and womens’ access to health care services, like Planned Parenthood, to prevent unwanted pregnancy.

J.D. Kleinke is a medical economist, author, and health information industry pioneer. His work has appeared in the Wall Street Journal, JAMA, Barron’s, the British Medical Journal, Modern Healthcare, and numerous other publications.  His books include “Bleeding Edge: The Business of Health Care in the New Century” (1998), “Oxymorons: The Myth of a U.S. Health Care System” (2001), and “Catching Babies” (2011), a novel about the training of OB/GYNs that will be published in March.

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J.D. Kleinke
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Abortion is “a crime against humanity” while the invasion of Iraq was a “defensive” war, vasectomy “causes auto-immune disease,” and everyone should have perfect pregnancies like me. Wow. Michele Bachmann for President!

I’m with Shelley and have had quite enough of this discussion as well.

But I will finish where I began this post: abortion is awful, but black market abortions are worse…for women, fetuses, and the public health.

Keep abortion safe and legal.

John Ballard
Guest

I think it’s time for this thread to be closed for further comments. It happens all the time at other blogs.

Pat
Guest
Pat

JD, wake up and smell the coffee! LEGAL abortions are killing women. Making it legal makes it LESS safe. That’s because abortionists are no longer afraid of being caught, so they have grown careless. Health departments are shutting down LEGAL abortion mills everywhere because they don’t meet the most basic health standards. They are filthy. Abortionists do not sterilize their instruments properly, if at all, and re-use disposable instruments. They let non-medical personnel prescribe drugs. I attended a hearing of the medical board where they considered disciplining an abortionist for doing that. They just slapped him on the wrist and… Read more »

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Shelley
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Shelley

Thank you for a very, very good article. The only area where I think you are off — I think the idea that if we only encourage poor women who want abortions to just give up the baby, so that rich women who have fertility problems can “just adopt,” is a gross oversimplification — not that there aren’t thousands of waiting parents who would be thrilled to adopt, but it is harder than hell to give up a child — and going through an unwanted pregnancy is no cakewalk, especially for women whose lives are unstable in any number of… Read more »

Pat
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Pat

Shelley, sure, it is agonizing to give up a child for adoption, but it is MORE agonizing to realize you killed your own child, and now it’s too late to do anything about it. Pregnancy is a NATURAL CONDITION. We women are made for it. If being pregnant is “no cakewalk”, it’s because of circumstances that really have nothing to do with the pregnancy itself. We need to encourage responsible behavior: no drugs, ever, no sex when you’re not prepared to have a child, etc. We can do plenty to make adoption a more attractive option, but the ready availability… Read more »

Shelley
Guest
Shelley

Wait, where did I say that the most helpful thing we can do for poor women is to help them kill their children? Pregnancy is a natural condition but it is still no cakewalk. I agree that we should make it easier for women to adopt if they are so inclined (as I stated in my response), but the idea that women whose lives are very unstable will suddenly be able to pull it together in the face of an unwanted pregnancy is naive. Your assert “we can do plenty to make adoption a more attractive option, but the ready… Read more »

Pat
Guest
Pat

Shelley, you didn’t say the most helpful thing we can do for poor women is to help them kill their children. Margaret Sanger did. She founded Planned Parenthood. Pregnancy CAN be a cakewalk. I had six pregnancies, and five of them were cakewalks. During my second pregnancy, I swam a mile twice a week. I played judo until four days before I gave birth. That last day, I was horsing around with my sister, who didn’t study judo, and she kicked me in the thigh and made a nasty bruise. It was fun when the nurse in the delivery room… Read more »

Shelley
Guest
Shelley

Pat, I’m so happy you had great, wanted pregnancies surrounded by supportive people. That’s generally not the reality of someone facing an unwanted pregnancy. And I’m genuinely glad your pregnancies were good for you physically. But before you congratulate yourself too much on that count, please understand — I eat right and take care of myself too but was not nearly as fortunate in my pregnancy, although I won’t bore you with the details. And you’re right — there are a lot of organizations who want to help pregnant women who might want to carry to term — and I… Read more »

Pat
Guest
Pat

Hey, Shelley, it’s OK not to continue the conversation. If you really mean it when you say you want to protect a woman’s right to choose, you need to do something about the 63% of women who say they were coerced into abortions they didn’t want. Even women who think they want an abortion can suffer terribly afterwards. One woman who was absolutely certain later became suicidal. I sat up with her all night, exchanging messages over the internet so she wouldn’t do it. I tried to call the suicide hotline in her city, 3000 miles away, and they left… Read more »

John Ballard
Guest

Shorter Pat — If everybody will agree with me all these hateful problems will vanish.

Edilyn Y.
Guest
Edilyn Y.

I agree that Planned Parenthood is good resource for those seeking preventative care such as birth control, health screenings which include pap smears, free condoms, and proper sex education. All of these things, if appropriate access is available, can help decrease the number of unwanted pregnancies and therefore decrease the number of abortions. The fact that Planned Parenthood touches base with the majority of taboos doesn’t sit too well with these politicians, but they have to remember that everyone should be entitled to the same healthcare rights and preventative care options. You are correct in that if these politicians wanted… Read more »

Pat
Guest
Pat

Edilyn, as a nurse, your duty is to BOTH your patients, and your oath requires you “do no harm” to EITHER of your patients. When you have a pregnant woman, you have TWO PATIENTS. The mere fact you can’t see the other one means harming that one is all the more despicable. Look into what Planned Parenthood really does. It sells abortions to women who don’t want them, aids and abets sex trafficking of minors, lies about fetal development, refuses to report child molestation and statutory rape, and in every way does its darndest to make sure nothing stands in… Read more »

J.D. Kleinke
Guest

If you are against abortion, do not have one. If you are a nurse who is against abortion, do not assist with one. The law protects your rights on both counts – and a whole lot more effectively than it protects women forced to face this horrifying choice. And if you are a male nurse who is against abortion, then get a vasectomy, as it is the single most effective birth control method after abstinence. Most abortions are the result of female birth control failures, not the result of girls and women who use it as birth control method because… Read more »

Pat
Guest
Pat

Hey, it’s not quite that simple. About 63% of women who had abortions reported being coerced. You’re right; the law doesn’t protect them. And no, the law does not protect a nurse’s right not to assist with one. It also doesn’t protect my right to go to ethical doctors only. The law forces doctors to participate, and this warps their ethics and their medical judgment. I speak from PERSONAL experience about what that does to decent medical care. Obamacare mandates that I must help pay for them, as do other federal laws. A woman deserves better than abortion. She should… Read more »

John Ballard
Guest

Thanks for this, Dr. Kleinke.
Keep up the good work.

John Ballard
Guest

Unfortunately, in this instance you are peeing into the ocean.
This person seems to have drunk too much of the wrong Kool-ade.

Gabriel Anderson
Guest

Genuinely beneficial appreciate it, I’m sure your visitors would possibly want a whole lot more blog posts like that maintain the great work.

Pat
Guest
Pat

Your article outraged and infuriated me. What right does anyone have to force ME to pay for an organization that does over 300,000 abortions a year? If you are right about market forces, we don’t need Planned Parenthood. Someone else will take up the slack. I find your implication that women will naturally resort to having sex to be extremely demeaning. It is not in our nature to sleep with men who don’t cherish us enough to protect us from abortion. Here is what your argument says to me. We are never going to stop rape completely. So let’s have… Read more »

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Sam
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Sam

oh, and to answer J.D.’s opening question, I hate abortions too, Every form of the procedure sickens me, and has since the time I was called to pick up a woman whose BP was mysteriously in the 60’s, about 20 minutes post procedure. The physician had apparently nicked her uterus on his way out, confirmed by the OR resuscitation team at the hospital, who performed an emergency hysterectomy on the patient. Her parents had to be called to tell them not to pick her up after school, the patient still didn’t have her license.

Sam
Guest
Sam

Interesting article. Peppering in demand and supply to a moral dilemma presently restrained by legal positivism is a first for me. It is legal positivism that the pro-abortion on demand crowd uses to shield from any form of disagreement from anyone who is convinced that destroying a human in utero is murder. In regards to framing abortions within the context of market economics, it is an erroneous assumption and a straw man argument to propose that pro-lifers (whatever that means!) are naive about the demand for on demand abortions. The issue so seemingly glossed over throughout the article is the… Read more »

Annie
Guest

Very interesting concept of the difference between someone who is ‘pro-life’ and someone who is ‘anti-choice’. Defunding the largest organization that promotes responsible sex is like shooting one’s self in the foot if you are pro-life. Defunding Planned Parenthood makes perfect sense if you wish to control the reproductive choices of women, thus you are anti-choice. Adoption is a beautiful wonderful thing, but it is not an alternative to pregnancy. Many women choose abortion because they cannot or do not want to be pregnant. Yes, let’s expand our adoption services! But one must always remember, a woman who wishes to… Read more »